Risk factors for surgical site infection after pancreatic surgery. A better postoperative antibiotic strategy is possible.

INTRODUCTION Pancreatic surgery is associated with high morbidity, mostly due to infectious complications, so many centres introduce postoperative antibiotics for all patients. However, antibiotic regimens vary according to local practices. The aims of this study were to describe the occurrence of surgical site infection (SSI) and antibiotic prescription after pancreatic surgery, and to determine the risk factors of postoperative SSI, in order to better define the clinical indications for the prescription of antibiotics in this context. PATIENTS AND METHODS All patients undergoing scheduled major pancreatic surgery from January 2007 to November 2018 were retrospectively included in the study. Patients were classified in four groups according to SSI and routine postoperative antibiotic (ATBpo) prescription as follows: SSI+/ATBpo+; SSI-/ATBpo+; SSI+/ATBpo-, SSI-/ATBpo-. In addition, risk factors (fever and preoperative biliary prosthesis) associated with the occurrence of SSI and with antibiotic prescription were analyzed using a logistic regression model. RESULTS Data from 149 patients (115 pancreaticoduodenectomies and 34 splenopancreatectomies) were analyzed. Thirty patients (20.1%) experienced SSI and 42 (28.2%) received postoperative antibiotics. We found no difference in routine postoperative antibiotic prescriptions (26.7% versus 28.6%, p=0.9) between patients with and without SSI. Amongst the 107 patients who were not routinely prescribed antibiotics postoperatively, 85 (79.4%) did not develop an SSI. In-hospital mortality did not differ between infected and non-infected patients (7% versus 2%, p=0.13). Postoperative fever was different between SSI+ and SSI- (73.3% versus 34.2%, p<0.001), while the prevalence of preoperative biliary prosthesis was similar (37.9% versus 26.7%, p=0.3). CONCLUSION Non-routine antibiotic prescription after major pancreatic surgery allowed us to appropriately spare antibiotics in 85 (56%) patients. This suggests that routine postoperative antibiotic prescription could be excessive, but further studies are needed to confirm such antibiotic stewardship. Fever appears to be a relevant clinical sign for individual-based prescription, whereas the presence of a biliary prosthesis does not.